The Minnesota Heart Survey (MHS) monitors, in an urban conglomeration, cardiovascular disease (CVD) morbidity and mortality simultaneously with CVD risk characteristics and their associated behaviors. This long-term study was proposed to improve the base for measuring, detecting, explaining and predicting trends in CVD. This proposal reports the substantial progress made by the MHS and its contributions to the understanding of CvD trends, knowledge which complements that from the few other systematic surveillance efforts in this country. We then provide a research plan for the future. Included in the MHS contributions are evidence of a continued decline in CvD deaths in this region, more rapid out-of-hospital than in; a recent flattened trend in stroke and in all-cause mortality; improved long-term survival after heart attack; a large increased use of therapeutic procedures; a lowering of major risk factor levels but a leveling off of hypertension control and a rise in average body weight. This renewal proposes ongoing collection and analysis of mortality data, hospital surveillance with a registry for incidence of coronary disease, a third risk factor survey, and analyses to test hypotheses about trends and to integrate all the data on risk, medical care and disease rates. It proposes to address a series of methodological issues crucial to surveillance in the U.S. because of dynamic changes in the natural history of CVD and its diagnosis and treatment. Competent, innovative and sustained CVD surveillance research, carried out in the context of trends in other major causes of death, is essential to rational public health policy and medical practice.